Find Your Routine: Consistency is Key
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them.
This week, we talked with Crystal Junkins, CCS, CPC, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
Q: Describe in detail your daily routine.
A: I’m an early bird – and so is my baby. I am up at 5:30 to feed the baby and have my first cup of coffee. I make breakfast for the two of us, and then switch off baby duty with my husband and the dog and I head upstairs to my office by 7:00. I read emails and go through my pending charts list, and then code until coffee break around 10. I code again until lunch and then break to feed the baby, and let the dog out. I finish coding around 3 in the afternoon, and then head right out the door to pick up the older kids from school – and then it’s homework, various sports and music lessons, prepping and eating dinner, reading, and then bedtime.
Q: How do you maintain your routine day after day, week after week?
A: I think I am just naturally a creature of habit. Health is a real priority, eating right, taking care of myself, getting enough sleep… all of that helps me maintain a regular rhythm at work as well as in my personal life as a mom to 3 busy boys. Our family life is so full of various schedules and responsibilities that the daily/weekly routine is pretty much created for me.
As far as coding goes, one obstacle I have noted to maintaining a rhythm mainly occurs when I am switching to a new client. I have often found it very challenging to start at a new client, especially since it definitely slows down my productivity quite a bit at first. However, I know that it has been a great asset for me professionally to learn how to adapt quickly to new clients, new relationships, new software, and new ways of approaching coding. HIA is constantly pushing me to grow, and that’s definitely one of the things I love about working here! So when I am starting a new client, I try to take some time to figure out the best workflow for that particular site, as it can vary so much from one place to another. They all abstract a bit differently or store their documents and information in new places. And then once I get into a fluent workflow, I stick with it. I generally go through every chart exactly the same way (abstract/discharge disposition, admit order, CDI notes, H&P, Discharge Summary, Op notes, Consults, Progress notes, anesthesia notes, labwork/etc). I think being consistent in this way helps me hit my productivity numbers at a new client faster.
Q: What techniques have you found to minimize distractions?
A: One thing that is very helpful is just the location of my office in our home. I am upstairs tucked away in a spare bedroom, far from the kitchen and living room downstairs which is often a bustle of activity between the comings and goings of my husband, the dog, the 2 older boys, the baby and the nanny who watches him during the day while I work. I really can’t hear much of anything up there! I also leave my cell phone on the charger in the kitchen during the day and just check it when I come downstairs for lunch or coffee. I focus a lot better when it’s quiet, so I usually don’t have music playing either.
Q: What are the productivity goals that you set for yourself? And how do you track them?
A: Well – it’s great that HIA does the productivity tracking for me! I just try to log in and do my best every day. Some days seem to flow really smoothly and feel easily productive. And then some days… just feel really slow and challenging. I try not to worry about the numbers and just figure that the good and the bad days will balance each other out in the end.
Q: What motivates you the most? Positive feedback from managers, self-motivation by reaching personal goals, financing incentives? Or other?
A: Yes, all of those things are motivating. But mostly, I just like to end every day feeling like I did a good job. My dad told me that was the most important thing – and he’s right.
TIP: I know for sure that I am not the fastest chart reader around, but I am definitely a fast typer. I am a piano performance graduate – so I know I have a head for memorizing information and fast fingers.
I am sure typing fast helps a lot, but more importantly, I think I am always looking for ways to type less. I know that CAC programs can be controversial, but I definitely make use of it as a tool when I am working for a client who is utilizing auto suggested codes. I use the CAC codes as much as possible, when I am confident that the suggested codes are correct. At first I was hesitant to use the codes the CAC was suggesting, but now that I am becoming more familiar with the I10 codes, I can save a lot of time by entering the codes and POA status through the CAC instead of typing it all in. The fewer key strokes the better! I know my productivity has gone up since I started making better use of the CAC.
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
Chances are, we all know someone affected by heart disease and stroke, because about 2,300 Americans die of cardiovascular disease each day, an average of 1 death every 38 seconds. But together we can change that.
There was a time when coding delivery records was considered simple. Many times, these types of records were given to the newer coders. However, as coding becomes more complex, this is no longer the case. With the implementation of ICD-10-CM came more codes for very detailed and specific issues that occur during pregnancy, childbirth and the puerperium.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Allison Curry, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
One way to shorten a lengthy query is by avoiding repetition in the supporting documentation. Does the same diagnosis really need to be mentioned multiple times in the clinical indicators? Is it necessary to list the results of a chest x-ray twice? Does listing the same documentation multiple times give further specification or explanation to the query?
Tobacco use can lead to tobacco/nicotine dependence and serious health problems. Quitting smoking greatly reduces the risk of developing smoking-related diseases. Tobacco/nicotine dependence is a condition that often requires repeated treatments, but there are helpful treatments and resources for quitting.
This is Part 5 of a five part series on the new 2019 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY 2019 and include examples to help the coder understand the new codes. There is 1 new lymphatic code, 2 new digestive system codes with 3 deletions, 3 new urinary system codes with one deletion and 7 deleted nervous system codes with 2 revisions.
This is Part 3 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 9 new cardiovascular CPT codes added with 2 deletions and 3 revisions.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Tilina Sablan, RHIT, CCS, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
This is Part 2 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 4 new musculoskeletal CPT codes added with 2 deletions and 0 revisions.
This is Part 1 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There were 15 new integumentary CPT codes added with 3 deletions and 1 revision.
In part 5 of our series, we look at DRG 64—Intracranial hemorrhage or cerebral infarction with MCC. For this DRG recommendation the majority (almost all) were recommended to DRG 65 (Intracranial hemorrhage or cerebral infarction with CC) with deletion of the reported MCC.
The majority of the recommendations from DRG 190 (Chronic obstructive pulmonary disease w/MCC) was to DRG 189 (Pulmonary edema and respiratory failure) with re-sequencing of respiratory failure as the PDX or adding as a new code and sequenced as PDX.
The majority of the recommendations from DRG 853 (Infectious & parasitic disease with O.R. procedure with MCC) were to DRG 871 (Septicemia w/o MV 96+ hours with MCC) with deletion or revision of the PCS code. Some of these required physician query.
The majority of the recommendations from DRG 872 (Septicemia w/o mechanical ventilation 96+ hours w/o MCC) were to DRG 871 (Septicemia w/o mechanical ventilation 96+ hours with MCC) with the addition of an MCC to the account. Not all of these required a physician query and were present in the medical record documentation without any clarification needed prior to coding.
The majority of the recommendations from DRG 871 (Septicemia w/o MV 96+ hours with MCC) were to DRG 872 (Septicemia w/o MV 96+ hours w/o MCC) with the recommendation to delete the reported MCC or query for clarification to support the MCC that had been reported.
Every year, we make plans to live a healthier, more organized, and balanced life. For some of us, we end up falling short of those expectations. This year, to keep us on track with our New Year’s goals, we have put together a few of the most common New Year’s resolutions along with their ICD-10 diagnoses codes. Check out our tips and tricks for a healthy 2019!
Top 5 ProFee diagnosis changes found in recent HIA reviews: 1. I10 – Essential (Primary) Hypertension; 2. E11.9 – Type 2 Diabetes Mellitus Without Complications; 3. K29.60 – Other Gastritis Without Bleeding; 4. R13.19 – Other Dysphagia; 5. I25.10 – Atherosclerotic Heart Disease of Native Coronary Artery Without Angina Pectoris.
What is the principal procedure? The procedure that is performed for definitive treatment or is taking care of a complication is the principal procedure. Procedures for diagnostic or exploratory purposes that are performed in addition to a procedure being performed for definitive treatment, would be reported in addition to the principal procedure.
A query question that is directive in nature, indicating what the provider should document, rather than asking for his/her professional determination of clinical facts, constitutes a leading query. The provider should not be made to feel obligated to document anything.
When I start coding a chart, I enter all account information in log and do any abstracting—disposition, admitting, and attending—take care of all of that first. ED, H&P, consult, progress reports, and discharge summary.
Some Speed Reading Tips: Once you start reading, don’t stop! Read the text straight through. If you have any question after you have completed reading the material, go back and reread the relevant sections. Reread the marked sections of the text (the items you indicated that you didn’t quite understand). Write a small summary at the beginning of the chapter – consisting about 3-4 sentences.
In HIA quality reviews we are finding that some coders are reporting Z41.2—Encounter for routine and ritual circumcision, during the male newborn birth admission, when circumcision is performed prior to discharge.
The cause/etiology of GI bleeding is not always easily determined. During procedures, to work the bleeding up, there are often multiple potential sources of bleeding found but not identified as the culprit. Many of these findings have “with” or “in” in the main or subterms.
On December 1, 2018, the HIA team based at our headquarters in Pawleys Island, South Carolina received a visit from a surprise guest – meet Otis, HIA’s very own Elf on a Shelf. Otis will be sticking around until Christmas to keep an eye on all of us. We have a feeling he may get into some trouble! Check back daily to see what Otis is up to. #OtisOnOtisDrive
COPD is a respiratory condition where there is chronic obstruction to airflow in the lungs. Air is breathed into the lungs but a patient with COPD has trouble emptying air out of the lungs. This can also cause patients with COPD to have CO2 retention. COPD is an irreversible and progressive disease in which the lung function worsens as time goes on.
Tissue findings interpreted by a pathologist are not equivalent to the attending physician’s medical diagnosis based on the patient’s clinical condition. If the attending physician has not indicated the significance of an abnormal finding within a pathology report…
It’s that time of the year where HIM professionals take a peek at what changes are coming for CPT in the new year, 2019. Did you know that CPT started in 1966 with about 3,500 codes? For 2019, there are a total of 10,294 CPT codes.